I'm sure he's not trying to get rid of you. Keeping you at that discounted rate definitely means he wants to keep you around. As to your last question, maybe you aren't his only client on that plan? Maybe he is having issues with that particular carrier (their rejecting claims, needing extra paperwork that is taking too much time) that have nothing to do with your particular case and their low coverage just doesn't make it feasible to continue working with them. I know if I were in your position, I would probably think there was some underhanded or unconscious attempt to push me away, but I really don't think that's what is going on here if I look at it objectively. And this is coming from someone that worried that T forgetting to turn off the button that clients press to tell them they are in the lobby meant he didn't want to know I was there, hence did not want to see me and wanted me to quit. I had to confess that to T. I think maybe it would be good to talk to your T about these projections and how it huts to feel like he's pushing you away even though intellectually you know that's not likely what is happening. Do you think you could do that?

Yaku,

Thank you for your unbiased opinion. I really appreciate it. It's so much easier to be rational when it's someone else, right? We did talk about it months ago and he reassured me that he wants to keep working with me. He has only been really reassuring, offering phone sessions when I went away and then not charging me for them. It's just this inner fear that I have that I'm not reading the signals and can't pick up when I'm not wanted and then stay longer in a relationship than I should.

And, no, I'm not the only client on the plan. I think he mentioned that he has 12 clients on the plan. That's a lot at $65.00 a session. As I said, I've done the math and I really can't blame him.

I actually placed an out of session call to him yesterday because I was in so much pain over the whole thing that I wasn't sure I was going to make it through the weekend. I called him at 9:30, left a message telling him I was going to a spin class and would be available around 11. He called at 11:15 and told me he doesn't want me to think about the insurance issue right now. It's not an issue for him, it's not going to come between our work together, etc. It was reassuring but I've been crying all weekend anyway. I think I will just tell him flat out, if he wants me to find another therapist, I will. That it will hurt but I will get over it and I would rather him tell me than to stay and worry. If he tells me flat out, he still wants to work with me, I will try to let it go.

Thanks again,

Liese

Liese,

I'm so sorry this is happening to you. It really does sound like he wants to keep working with you given that he's willing to work with you for $65 when he clearly charges more for other sessions. Having said that from a very logical perspective I can really relate to how you feel. When my insurance ran out my T was encouraging me to find a new T as his fees were so high (they were fixed by the hospital and he had no control over it)and all I could hear was "go and find a new T I don't want to work with you any more" I'm sorry I don't have any advice I just wanted to say that I understand how upsetting this must be.

Daisy.

Liese,

It really does sound like he definitely wants to keep you on and doesn't want you to worry about it. If he wanted you to leave he could have said that from the point that he drops your insurance forward that he's going to charge his standard fee of $125. Really, I don't think he is trying to get rid of you at all!

You are really lucky that he is still willing to see you for $65. That is a steal in this line of work and I agree that he must not be making that much money at that rate. My T recently raised her fees and she had a statement on the notice saying that if the fees were too high she would be happy to help anyone who needed it to find more affordable care. Even though (right now) that didn't apply to me, it still stung a bit. It was so impersonal and like it wouldn't be a big deal to her at all if someone had to leave because of the fee increase. I know that my T does NOT negotiate fees at all. You either pay her in full or you don't come. I totally understand why it is, but it freaks me out because if my insurance changes drastically I will have a significant issue maintaining the level of care that I'm getting right now. I thought my therapy was running about 20K a year, but this year it looks like it's going to be about 28K. No way in heck do I have even close to that kind of $$ out of pocket.

Sorry, went off on a tangent there! I'm glad you clarified with your T and he has stated he wants to work with you. I really and truly think he is being genuine here!

Thanks Daisy and STRM,

I get that he makes his living from this. And we live in an expensive area of the country. Even considering that, his fees are very reasonable. I can cough up the money and pay him. That's not going to be an issue for me, I hope. I just don't want to stay somewhere I'm not wanted. I thought that I could change insurance plans every June and get the 30 visits from each plan that way. That could work!

Almost Monday! See T on Monday and maybe I can put this baby to rest once and for all.

Liese

Liease – it makes a lot of sense why he would drop the plan. That is a crummy rate, especially for so many clients. T’s have to sign different contracts with different companies. For many companies, a T can refuse to take on any NEW clients of a plan and still accept the plan… but when a T already has 12 clients on a plan, and he’s being paid at about a 50% rate, and the majority of the money comes from the client – I think it’s probably just simply not continuing to be worth his time to even bill this insurance company (and it takes a considerable amount of time to bill insurance companies). I totally understand and can relate with why you are concerned he is leaving you (I have the same fears) but from the outside, I don’t see anything about this that would concern me or indicate to me that he is. In fact, I think he is actually really committed to you – as evidenced by his willingness to keep seeing you at a reduced rate. If he was wanting to end, he could totally take advantage from this and use it to end – but it doesn’t sound like that at all.

Plus, other things you have written about him indicate he’s staying… and he seems like the kind of guy who is willing to deal with hard stuff in a more direct way… I totally relate to your fears and I would probably be just as concerned as you if I was in your shoes. However, from the outside, I don’t think this is any sign at all that he wants to end. I don’t think you are missing any signs of him wanting to end. I think it really just has become not worth his time to keep battling with an insurance company that is seriously short changing him on a large number of clients.

Most T’s have around 20-35 clients in their practice – so 12 is a lot. Many T’s just don’t even take any insurances anymore because the billing processes take up so much time. My own T offered to do a single case agreement with my insurance company, but they ended up being so cumbersome to bill that she said it was more cost effective for her to just take what I would pay as a co-pay, write off the rest, and not bother billing my insurance. She is very committed to me, and I think your T is too.

Are the 30 sessions a lifetime limit? or are they 30 sessions per year? If you can switch insurance plans, maybe you could tell him you were planning on switching anyhow, and ask him what insurance plans reimburse him well. I know this is a little besides the point though - it sounds like the main thing you need is reassurance you are wanted and he really is willing to work with you. I really think he is and I really hope you talk with him about it more.

hang in there,
~jd

Liese,

Don't most insurance companies exempt pre-existing stuff now? I'd think it would be hard to switch companies on a private plan that way, but maybe I'm out of the loop. We've always had plans through my husband's job.

My T doesn't even contract with any insurance companies at all. She is covered on my insurance as out of network and she files for me as a courtesy, but she is not contracted with any company because she won't take the reduced fees. Her fees are really reasonable, especially for her level of expertise so I don't blame her.

Jane, DF and STRM,

Thanks for all the reassurance. This insurance issue I guess is really touching my core issue of not being wanted so I'm hoping that some good work will come out of this with T. My insurance agent reassured me that I can switch plans, that the preexisting condition stuff doesn't apply to me because of some 9 month rule that I didn't quite catch. Something to do with state law. But basically she said it woudln't be a problem. I get 30 visits per calendar year and so if I switched now to the plan I was looking at, I would get another 30 visits.

Here's another question. The plan I have now includes in the contract unlimited visits if you have a biologically based disorder. T changed my diagnosis from adjustment disorder to panic disorder, which is biologically based so we could take advantage of the unlimited visits. The insurance company denied my request for unlimited visits. We appealed. And it was denied again. This time, it was denied because I am not on meds. I am going to appeal it again.

My question is this: the new plan I want to switch to does NOT include unlimited visits for biologically based disorders. However, I can purchase a rider that would add that to my plan for a small amount of money. And, so since it is a rider that I am purchasing, does that mean they won't fight me on it like my current insurance company is doing? Why switch if they aren't going to cover the additional therapy anyway? Although, I would get another 30 visits this year.

Liese

Liese,

I am sorry to hear your T is dropping this health insurance plan. I can see how you might read into Ts decision to discontinue this plan as a means of getting rid of you, but I seriously doubt that has anything to do with it. From what you've written, it sounds like T has truly bent over backwards to accommodate several patients who cannot afford his full fee, but ha been doing so at his own expense. I'm sure it isn't easy for him to make these changes, but at the end of the day, this is how he makes a living and if he needs to change his policies to make more money, its not about his not wanting to work with particular clients but is simply a matter of needing to make more money.

I don't know much about insurance, so I am not able to answer your other question about the insurance rider, etc.

Liese,

Well, if you can switch insurance and get another 30 visits then I would do that. I can't say for sure about the rider. I guess it depends on how much it costs vs paying out of pocket. There is never a guarantee with insurance, but perhaps with them getting the initial diagnosis of anxiety then they would be willing to pay.